Provider Demographics
NPI:1881729705
Name:DERN, WILLIAM M (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:DERN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 CASSIDY ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6033
Mailing Address - Country:US
Mailing Address - Phone:760-433-6111
Mailing Address - Fax:760-433-4819
Practice Address - Street 1:605 CASSIDY ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6033
Practice Address - Country:US
Practice Address - Phone:760-433-6111
Practice Address - Fax:760-433-4819
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255061223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics